Cardiothoracic Surgery CESR Portfolio Guide

Able to perform all the administrative and clinical tasks required of a consultant surgeon in order that all patients presenting as outpatients in the specialty are care for safely and appropriately

• Assesses and prioritises GP and inter-departmental referrals and deals correctly with inappropriate referrals
• Assesses new and review patients using a structured history and a focused clinical examination to perform a full clinical assessment, and determines the appropriate plan of action, explains it to the patient and carries out the plan
• Carries out syllabus defined practical investigations or procedures within the out-patient setting
• Adapts approach to accommodate all channels of communication (e.g. interpreter, sign language), communicates using language understandable to the patient, and demonstrates communication skills with particular regard to breaking bad news
• Takes co-morbidities into account
• Requests appropriate investigations, does not investigate when not necessary, and interprets results of investigations in context
• Selects patients with urgent conditions who should be admitted from clinic
• Manages potentially difficult or challenging interpersonal situations, including breaking bad news and complaints
• Completes all required documentation
• Makes good use of time
• Uses consultation to emphasise health promotion

All patients with an emergency condition requiring management within the specialty. Able to perform all the administrative and clinical tasks required of a consultant surgeon in order that all patients presenting as emergencies in the specialty are cared for safely and appropriately

• Promptly assesses acutely unwell and deteriorating patients, delivers resuscitative treatment and initial management, and ensures sepsis is recognised and treated in compliance with protocol
• Makes a full assessment of patients by taking a structured history and by performing a focused clinical examination, and requests, interprets and discusses appropriate investigations to synthesise findings into an appropriate overall impression, management plan and diagnosis
• Identifies, accounts for and manages co-morbidity in the context of the surgical presentation, referring for specialist advice when necessary
• Selects patients for conservative and operative treatment plans as appropriate, explaining these to the patient, and carrying them out
• Demonstrates effective communication with colleagues, patients and relatives
• Makes appropriate peri- and post-operative management plans in conjunction with anaesthetic colleagues
• Delivers ongoing post-operative surgical care in ward and critical care settings, recognising and appropriately managing medical and surgical complications, and referring for specialist care when necessary
• Makes appropriate discharge and follow up arrangements
• Carries out all operative procedures as described in the syllabus
• Manages potentially difficult or challenging interpersonal situations
• Gives and receives appropriate handover

Manages all hospital in-patients with conditions requiring management within the specialty. Able to perform all the administrative and clinical tasks required of a consultant surgeon in order that all inpatients requiring care within the specialty are cared for safely and appropriately

• Identifies at the start of a ward round if there are acutely unwell patients who require immediate attention
• Ensures that all necessary members of the multi-disciplinary team are present, knows what is expected of them and what each other’s roles and contributions will be, and contributes effectively to cross specialty working
• Ensures that all documentation (including results of investigations) will be available when required and interprets them appropriately
• Makes a full assessment of patients by taking a structured history and by performing a focused clinical examination, and requests, interprets and discusses appropriate investigations to synthesise findings into an appropriate overall impression, management plan and diagnosis
• Identifies when the clinical course is progressing as expected and when medical or surgical complications are developing, and recognises when operative intervention or re-intervention is required and ensures this is carried out
• Identifies and initially manages co-morbidity and medical complications, referring on to other specialties as appropriate
• Contributes effectively to level 2 and level 3 care
• Makes good use of time, ensuring all necessary assessments are made and discussions held, while continuing to make progress with the overall workload of the ward round
• Identifies when further therapeutic manoeuvres are not in the patient’s best interests, initiates palliative care, refers for specialist advice as required, and discusses plans with the patient and their family
• Summarises important points at the end of the ward rounds and ensures all members of the multi-disciplinary team understand the management plans and their roles within them
• Gives appropriate advice for discharge documentation and follow-up

All patients with conditions requiring operative treatment within the specialty. Able to perform all the administrative and clinical tasks required of a consultant surgeon in order that all patients requiring operative treatment receive it safely and appropriately

• Selects patients appropriately for surgery, taking the surgical condition, co-morbidities, medication and investigations into account, and adds the patient to the waiting list with appropriate priority
• Negotiates reasonable treatment options and shares decision-making with patients
• Takes informed consent in line with national legislation or applies national legislation for patients who are not competent to give consent
• Arranges anaesthetic assessment as required
• Undertakes the appropriate process to list the patient for surgery
• Prepares the operating list, accounting for case mix, skill mix, operating time, clinical priorities, and patient co-morbidity
• Leads the brief and debrief and ensures all relevant points are covered for all patients on the operating list
• Ensures the WHO checklist (or equivalent) is completed for each patient at both the beginning and end of each procedure
• Understands when prophylactic antibiotics should be prescribed and follows local protocol
• Synthesises the patient’s surgical condition, the technical details of the operation, comorbidities and medication into an appropriate operative plan for the patient
• Carries out the operative procedures to the required level for the phase of training as described in the specialty syllabus
• Uses good judgement to adapt operative strategy to take account of pathological findings and any changes in clinical condition
• Undertakes the operation in a technically safe manner, using time efficiently
• Demonstrates good application of knowledge and non-technical skills in the operating theatre, including situation awareness, decision-making, communication, leadership, and teamwork
• Writes a full operation note for each patient, ensuring inclusion of all post-operative instructions
• Reviews all patients post-operatively
• Manages complications safely, requesting help from colleagues where required

Manages all patients with conditions requiring interdisciplinary management including care within the specialty. Able to perform all the administrative and clinical tasks of a consultant surgeon in order that safe and appropriate multi-disciplinary decisions are made on all patients with conditions requiring care within the specialty.

• Appropriately selects patients who require discussion at the multi-disciplinary team
• Follows the appropriate administrative process
• Deals correctly with inappropriate referrals for discussion
• Presents relevant case history, recognising important clinical features, co-morbidities and investigations
• Identifies patients with unusual, serious or urgent conditions
• Engages constructively with all members of the multi-disciplinary team in reaching an agreed management decision, taking co-morbidities into account, recognising when uncertainty exists, and being able to manage this
• Effectively manages potentially challenging situations such as conflicting opinions
• Develops a clear management plan and communicates discussion outcomes and subsequent plans by appropriate means to the patient, GP and administrative staff as appropriate
• Manages time to ensure the case list is discussed in the time available
• Arranges follow up investigations when appropriate and knows indications for follow up

Able to perform all administrative and clinical tasks required of a consultant surgeon for all patients within the intensive care and high dependency settings in both cardiac and thoracic surgery to ensure they receive safe an appropriate care.

• Assesses referrals to ICU or HDU, and regularly reviews patients
• Arranges urgent investigations as necessary and reviews in a timely fashion
• Works with appropriate specialties in the management of critically ill patients, referring on to other specialties as appropriate
• Leads on surgical decisions for post-operative patients
• Supports nursing and anaesthetic staff in managing patients
• Plans discharges in a timely fashion to maintain patient flow
• Communicates appropriately with family and next of kin
• Communicates appropriately with consultant, nursing and anaesthetic colleagues
• Delegates and trains other staff members on appropriate cases
• Applies syllabus defined knowledge and clinical skills in all cases
• Carries out syllabus defined practical investigations or procedures within HDU and ICU
• Exercises good judgement in deciding on management plans and executes these within appropriate timescales
• Effectively manages potentially challenging situations in patients

Able to assess surgical outcomes in the specialty at a personal and unit level, and to respond to or adapt practice, where appropriate, without compromising patient care.

• Assesses pre-operative investigations to collect risk factors
• Collects data at the time of surgery about patient demographics, procedure performed and risk factors
• Enters data into local and national datasets as appropriate
• Collects post-operative data of outcomes following surgery
• Analyses and presents surgical outcome data at local audit meetings
• Describes both personal and unit outcomes during a prescribed audit period
• Describes risk adjusted outcomes at personal and unit level
• Demonstrates ability to recognise acceptable variations in practice as well as excellent and poor performance in self and others
• Promotes excellence in meeting standards to improve the quality and outcomes of surgical practice
• Demonstrates ability to analyse reasons for poor performance and suggest means for adapting practice to improve patient care
• Demonstrates knowledge of risk factors, current risk models (such as EuroSCORE, Thoracoscore etc.), and risk adjustment
• Demonstrates knowledge of national and local audits (SCTS, NICOR, cancer registries etc.)
• Demonstrates skills in using IT and databases

Currency Window

Evidence drawn from the last six years of clinical practice prior to submission (WTE). If you have had a break in practice, 50% of evidence of competency in critical conditions (CBDs) and emergency index procedures (PBAs) should be drawn from the last two years clinical practice (falling within the last five calendar years).

Evidence Volume

800-1000 pages